Comparison of Hysteroscopic and Blind Endometrial Biopsy Techniques in Postmenopausal Women

To compare the tissue adequacy of hysteroscopy-guided endometrial biopsy using 2 different instruments and blind Pipelle biopsy in postmenopausal women with suspected endometrial pathology.

This prospective, single-center, paired comparative study included postmenopausal women evaluated for abnormal uterine bleeding or increased endometrial thickness. All participants underwent hysteroscopy-guided biopsy using spoon and grasper forceps, followed by blind Pipelle endometrial sampling during the same session. Biopsy adequacy was assessed based on predefined histopathological criteria, including cellular adequacy and tissue volume adequacy. Differences in adequacy rates among techniques were analyzed using Cochran's Q test, with pairwise comparisons performed using the exact McNemar test.

A total of 51 patients were included in the final analysis. Adequate tissue samples were obtained in 72.5% of hysteroscopic spoon forceps biopsies, 84.3% of hysteroscopic grasper forceps biopsies, and 94.1% of Pipelle biopsies. Overall differences in adequacy rates among the three techniques were statistically significant (P = .0106). Pairwise analysis demonstrated a significantly higher adequacy rate for Pipelle biopsy compared with spoon forceps (P = .0127), whereas no significant differences were observed between Pipelle and grasper forceps or between grasper and spoon forceps. Among inadequate samples, cellular insufficiency was the predominant cause across all techniques.

Pipelle endometrial biopsy provides the highest rate of tissue adequacy in postmenopausal women; however, hysteroscopy-guided biopsy-particularly with grasper forceps-also yields acceptable adequacy and offers the advantage of targeted sampling. Cellular insufficiency appears to be the primary limitation to tissue adequacy in postmenopausal endometrium.